Postoperative Inflammatory Marker Trends as Early Predictors of Delayed Gastrointestinal Recovery after Elective Abdominal Surgery

Abstract

Elective abdominal surgery led to prolonged hospital stay and higher healthcare burden due to delayed gastrointestinal (GI) recovery. Early postoperative trends of inflammatory markers were monitored routinely, however, their predictive value of non-infectious functional bowel impairment was not well characterized. In this study, the researchers were interested in finding out if the levels of inflammatory markers over time in the first few days after surgery are predictive of delayed recovery of the gut following an elective surgery involving the abdomen. This was a retrospective observational analytical study of the electronic medical records of a tertiary surgical centre in the Industrial & Urban Core Punjab Province from January 2023 to December 2024. A total of 180 adult elective abdominal surgery patients were included in the final analysed cohort, who met all eligibility criteria. Primary exposure variables were serial levels of inflammatory markers (C-reactive protein and neutrophil-to-lymphocyte ratio from day 1 to day 3 after surgery), and the primary outcome was delayed gastrointestinal recovery. IBM SPSS was used for bivariate statistical comparisons and for multivariable logistic regression. 23.9% of the patients had delayed gastrointestinal recovery. Patients with delayed recovery had significantly elevated POD3 CRP levels (148.6 \pm 32.1 mg/L vs 76.2 \pm 21.4 mg/L, p < 0.001). Multivariable logistic regression revealed that a positive C-reactive protein delta trajectory from day one to day three (Adjusted Odds Ratio = 3.84, 95% Confidence Interval: 1.92–7.68; p < 0.001) and an elevated day three neutrophil-to-lymphocyte ratio greater than 7.5 (Adjusted Odds Ratio = 2.95, 95% Confidence Interval: 1.41–6.18; p = 0.004) were independently associated with delayed functional bowel recovery. The study found that trajectories of inflammatory markers (increased C-reactive protein) and neutrophil-to-lymphocyte ratio, were associated with delayed gastrointestinal recovery. These biomarkers could be tracked routinely in the early period after surgery, which could aid in early clinical classification of risk and allow for proactive management prior to the onset of clinical bowel dysfunction.